Women in detention described violations such as shackling pregnant detainees or failing to follow up on signs of breast and cervical cancer, as well as basic affronts to their dignity. Because immigration detention is the fastest-growing form of incarceration in the United States, these abuses are especially dangerous. They remain largely hidden from public scrutiny or effective oversight.

Meghan Rhoad, US researcher for the Women’s Rights Division

(Miami) - The medical care system in US immigration detention is dangerously inadequate, with unique consequences for women, and improving health care for immigration detainees should be a top priority for the new administration, Human Rights Watch and the Florida Immigrant Advocacy Center (FIAC) said. In two reports released today, Human Rights Watch and FIAC document numerous instances in which Immigration and Customs Enforcement (ICE) botched, delayed or denied medical care, causing suffering and even death.

"Women in detention described violations such as shackling pregnant detainees or failing to follow up on signs of breast and cervical cancer, as well as basic affronts to their dignity," said Meghan Rhoad, researcher in the women's rights division at Human Rights Watch. "Because immigration detention is the fastest-growing form of incarceration in the United States, these abuses are especially dangerous. They remain largely hidden from public scrutiny or effective oversight."

Women described struggling to obtain potentially life-saving services such as Pap smears to detect cervical cancer, mammograms to check for breast cancer, pre-natal care, counseling for survivors of violence, and even basic supplies such as sanitary pads or breast pumps for nursing mothers. The obstacles to health services included inadequate communication about available services, unexplained delays in treatment, unwarranted denial of services, breaches of confidentiality, and failure to transfer medical records. When women were denied services, complaint mechanisms were ineffective.

The 78-page FIAC report, "Dying for Decent Care: Bad Medicine in Immigration Custody," identifies major problems resulting in poor, and sometimes appalling, response to health problems. These include: a lack of independent oversight to ensure the quality and effectiveness of detainee medical care; delayed and denied care; shortages of qualified staff; improper care of mentally ill patients and physically disabled patients; problems with medication; difficulty gaining access to medical records; a lack of competent, professional interpreters; cruel and abusive behavior by some clinic and detention staff; unsanitary and overcrowded facilities; and the transfer or segregation of detainees in retaliation for medical complaints.

"Death rates in detention appear to be worsening," said Cheryl Little, executive director of FIAC. "ICE needlessly detains people with severe illnesses and those who pose no harm to US communities. Doing so drives up ICE costs even as the agency provides increasingly inadequate medical and mental health care to those in its custody."

The FIAC report is based on interviews, phone conversations and correspondence with detainees, as well as jail and immigration officials. It also includes information from US government materials, newspaper articles and other data.

The Human Rights Watch report is based on visits to nine detention centers in Florida, Texas, and Arizona, and interviews with 48 women detained or recently released from immigration detention, detention facility staff and health care providers, immigration officials, immigration attorneys and advocates. Additional research was conducted in the New York and Washington, DC, metropolitan areas.

More than 300,000 people were in immigration custody in the last year alone. The majority of immigration detainees are held by state and county jails under agreements with the federal agency. Women constitute roughly 10 percent of the immigration detention population. Immigration law violations are civil, not criminal, infractions; immigration detainees are held in administrative - not punitive - custody. The average stay in custody is 38 days, but some detainees are held for months and even years.

Under international standards, detainees are entitled to the same level of medical care as individuals in the community at large. However, the immigration agency's policy focuses on emergency care. The policy on off-site medical visits allows for non-emergency care only when lack of treatment would "cause deterioration of the detainee's health or uncontrolled suffering affecting his/her deportation status." This policy exists alongside a set of detention standards that were recently revised to include more detailed medical care requirements for facilities. The revised detention standards take effect in 2010.

"Recent policy revisions by immigration authorities contain important improvements, but much more remains to be done to develop adequate policies, ensure their proper implementation, and open up the detention system to effective oversight," said Rhoad. "The shortcomings in medical care affect both men and women, but fixing the system will require a special effort to identify and attend to the unique health care needs of women in detention."

Human Rights Watch and FIAC called on the new administration to:

Ensure that those currently detained - including ill, nursing and pregnant individuals as well as asylum seekers and others who shouldn't be detained - are fairly and quickly considered for parole and alternatives to detention;

Issue federal regulations so that the immigration agency's detention standards have the force of law, and detained individuals and their advocates have recourse to courts to redress shortfalls in health care; and

Revamp policies limiting access to non-emergency services.

To protect the health and rights of women in custody, Human Rights Watch also called on the government to:

Stop detaining women who are suffering the effects of persecution or abuse, or who are pregnant or nursing infants;

"Only independent, external scrutiny of detainees' medical care will ensure that the Department of Homeland Security and ICE carry out their moral and legal responsibility to provide for the health and safety of detainees entrusted to their care," said Susana Barciela, policy director at FIAC.

Select accounts from the FIAC report:

"At the clinic, I could no longer speak, only cry. A nurse told me she was sorry, but that the doctor had resigned so there was no doctor. I sat in a chair and clutched my stomach. ... I thought I was going to die."

- Miguel Bonilla Cardona, who suffered a ruptured appendix at an ICE-contracted county jail in central Florida

"Immediately, my body started shaking. I felt so cold that I thought I was freezing to death, but at the same time I was sweating. ... Within minutes, I had a seizure and my body began to shake so violently that I fell off the bed onto the floor."

- Zena T. Asfaw, on her near-death experience after being forced to take the wrong medication at a California detention facility

Select accounts from the Human Rights Watch report:

"I worry about my breast a lot. I told my family, ‘Don't ask me to [appeal my immigration case].' I'm not well and I would have to stay without medical care. I don't know from month to month ... things can get worse in my breast. It's hurting me. What was I supposed to do, die of cancer here? With adequate care, yes, I would stay until the end. Because 22 years of my life [have been in the US]. My kids are 12 and the United States is all they know. Depression, inadequate food, detention? Yes, still I would have fought it indefinitely."

- Antoinette L., Arizona, May 2008

"I was supposed to be checked [with a Pap smear] every six months. I asked my daughter to send the records. I got it and I brought it to medical so they could see I'm not lying. I have asked a lot of times. ... It's terrible because you feel like you have something you can die for ... and you don't have no assistance."

- Lucia C., New Jersey, May 2008. Lucia C. did not receive a Pap smear in over 16 months in detention.